Pierre Sean Brotherton: Revolutionary Medicine: Health and the Body in Post-Soviet Cuba

Article excerpt

Pierre Sean Brotherton

Revolutionary Medicine: Health and the Body in Post-Soviet Cuba

Durham, NC: Duke University Press, 2012, xxvii + 288 pp.

Declaring that "socialism was under siege," in 1991 the Cuban government attempted to revive the economy through policies and institutional practices that changed the lived experiences of its citizenry. Based on a decade of research conducted in Havana (1998-2010), Brotherton engages ethnographic, historical, and epistemological modes of analysis to explore two themes: first, how government health campaigns affected individual lives and changed the relationship among citizens, government institutions, public associations, and the state; second, how the collapse of the Soviet bloc and the strengthening of the US embargo are changing the relationship between socialist health policies and individual practices and how these changes have redefined the way in which state power becomes enacted through and upon individual bodies (3-4).

In a series of penetrating vignettes, Brotherton chronicles the experiences of physicians, everyday citizens, public health officials, and research scientists participating in the country's primary health program--the Programa del Medico y la Enferma de la Familia (MEF). The program requires family physicians and nurse teams to live and work in small clinics (consultorios) on the city block or in the rural community they serve (3-4). His perceptive analysis and assessment of the day-to-day lives of Cubans enabled Brotherton to convey cogently the way that the changing wider socio-economic circumstances were imprinted on the bodies of Cubans through "physical and mental ailments" and were "palpably and materially experienced through deep senses of loss, betrayal, disillusion, and longing" (3).

This ethnographic study is divided into three sections: Part 1 examines how, in the context of the economic decline of the health care sector, individuals negotiated the role of the state in providing health and welfare and their own personal desires to seek comprehensive health care. Part 2 examines the mechanisms and practices through which power relations operate in the primary health care system. It explores the relationship between health ideology as an explicit discourse and lived experience. Part 3 considers how Cuba's shifting state policies and external global factors have interacted with each other to change the course and practice of health and medicine in the nation.

Brotherton convincingly demonstrates that the state's effort "to shift the cradle-to-grave expectations" of health care, to those more in line with the capitalist market economy, resulted in greater numbers of individuals depending on lo informal practices to attend to their health care needs. …